Technology for Adherence

Author: Greg A. Muffler

Technology that helps increase communication can improve patient outcomes.
The Affordable Care Act, recently upheld by the Supreme Court, is expected to add tens of millions of health care consumers to the market. At the same time, the health care industry has a shortage of trained professionals. Clearly, a potential response to this looming shortage is to get patients to take more accountability for their own health and, in certain demographics, to demonstrate an interest in increased involvement not only in their own health care management, but health and wellness in general. However, there are arguably 90,000,000 people in the United States alone who are considered to have low health literacy, not to mention basic language barriers that make health literacy a challenge regardless of education level.

Given these factors, how will the health care market step up and be able to address these challenges and, at the same time, improve patient care and outcomes while lowering costs?

Despite the significant attention it continues to receive given the corresponding global cost impact, medication nonadherence is far from a new issue. Ensuring that patients take their medication on time and as instructed is an ongoing battle that begs a solution. With the ubiquity of technology, such as mobile phones, tablets, PCs, and the implicit possibilities these technologies represent, there is a great opportunity to harness the power of digital and mobile health—commonly referred to as “mHealth”—to influence patient behavior and improve outcomes. In order to be effective, however, the mHealth tools need to be integrated, intuitive, easy to use, and offer dialogue between patients, providers, payers, and, importantly, pharmacies. While technology itself won’t solve the problem, combining practical, innovative technology solutions that target patient behaviors and inhibitors to adherence with coordinated, value-based patient care versus fee for service is a big step in the right direction.

Technology Can Help Overcome Inhibitors

Why is mHealth so important? Because it meets patients where they are.

According to Pew Internet Research, three-fourths of US adults go online. Eight in 10 adults have a cell phone. Six in 10 adults go online wirelessly with a laptop or mobile device. Half of adult cell phone owners have apps on their phone.

Pew Internet Research also shows that people are using these technologies to connect with up-to-date health information and, more powerfully, with one another.

There are many health and wellness apps available—from apps that offer fitness tips to those that keep personal health records. Yet, the quality of available apps, particularly those related to health and wellness management, ranges widely.The good: Many health apps are designed with user benefits and user intention in mind. They’re easy to use and provide easy-to-understand information immediately, which is why people keep utilizing them.

The bad: These are the health apps that don’t take into account the individual patient or the patient’s lifestyle. For example, there are many apps for people with diabetes that aren’t necessarily designed by people with diabetes or people who fully understand the disease. These apps don’t take into consideration the activities individuals with diabetes go through each day and the challenges they face. Adherence is about changing behavior in the context of numerous patient lifestyle variables, not digitally superimposing a “one-sizefits-all” process.

Why Apps Aren’t Enough

With a few exceptions, mHealth apps tend to be stand-alone or disconnected from a larger network of payer/provider/ pharmacy information. They also tend to have a very specific use that is not expandable among a larger collection of tools to help patients and their caregivers communicate.

This lack of integration requires patients to enter their own medication history and health history. If patients already struggle to take their medication correctly, why would we believe that they will take the time to enter very detailed and specific information into an app—and then actually use it?

What is an mHealth platform? In the case of medication adherence, the mHealth platform has the capability to securely interface with health care systems, such as Electronic Medical Records (EMRs), a pharmacy management system, a payer or insurance claims system, or other legacy systems. More importantly, a platform allows pre-population of patient information (eg, drug history, claims history, etc) to take advantage of data sources.

Through such a platform, aggregated information is used in a secure, HIPAAcompliant fashion to communicate with patients. A business rules engine (one that incorporates predictive analytics, behavioral data, patient profile, EMR data, history, etc) allows pharmacies and health care companies the ability to customize communication with patients, following the correct protocol and using the optimal engagement profile for each individual patient.

mHealth platforms have other advantages as well. For one, they can be “private labeled,” which means the platform can be branded in the pharmacy’s or payer’s name. Doing so elicits a high level of trust with patients, who already have some loyalty to the brand, which allows for faster patient adoption. Internally, it speeds up the go-to-market time because the customized platform has functionality already built in. Typically, such platforms only require a 20% to 30% customization of the platform for the business rules and the user experience.

Secondly, mHealth platforms can be modified to reach audiences who have low health literacy. The mHealth platform can be used to deliver rich multimedia medication adherence/ administration instructions (for example, online and mobile streaming videos) written to a fifth- or sixth-grade reading level in languages ranging from English and Spanish to simplified and traditional Chinese characters, Korean, Russian, and Bengali. Large fonts also are available for people with impaired vision, as are videos to demonstrate medications that may be difficult to use. (For example, http://mhealthwatch.com/ polyglot-partners-with-cellepathicrx-formedication-adherence-18856/.)

Additionally, mHealth platforms can deliver patient analytics in a way that no other app can. The platform gathers “transactional exhaust”—which is a byproduct of patient interaction and behaviors—and delivers it in an easy-tounderstand dashboard report for providers. Depending on the intended audience, payers, providers, or pharmacies can log in and get appropriate levels of information and insight into patient adherence, all in an HIPAA-compliant environment.

Influencing Outcomes

Most importantly, a robust mHealth platform can influence patient outcomes. It allows caregivers to become more educated about their patients and gain insights into patient behavior. At the same time, the patient is more educated and tuned in to adherence. The payer gets a lower health care cost and can potentially offer lower health care premiums. In short, better outcomes equals lower premiums and lower health care costs.

We already know that there is significant evidence that traditional adherence methods, such as interactive voice response systems, letters, and automated patient communication improve adherence, increase pull-through at pharmacies, and improve top-line revenue for pharmaceutical manufacturers.

The promise of mHealth—in concert with outcomes-based incentives—is to leverage the ubiquity of this new technology with more engaged patients and a motivated value chain, including payers, providers, pharmacies, and pharmaceutical manufacturers. The result is a much more intimate and direct 2-way patient dialogue than is possible with traditional patient communication alone.

Greg A. Muffler is an mHealth executive, mobile strategist, and entrepreneur who has served in senior leadership roles with several large and start-up organizations. Before co-founding CellepathicRx, he co-founded a Cleveland-based IT management consulting firm specializing in health information technology and served as chief executive officer. Previously, he was general manager for TITAN Technology Partners, a global managed services ERP firm headquartered in Charlotte, North Carolina.